Retrospective Study from a Single Center in Poland of Postoperative Outcomes of Muscle Strength in Patients After Surgical Suturing of the Achilles Tendon Using a Kessler's Suture and 28 Weeks of Supervised Postoperative Physiotherapy.

BACKGROUND A retrospective study from a single center in Poland was aimed to evaluate the effect of 47 supervised physiotherapy (SVPh) visits on relative peak torque (RPT) and relative isometric torque (RIT) of foot plantar flexion muscles (FPFM) and foot dorsiflexion muscles (FDFM) with a frequency of 1.7 visits per week conducted for 28 weeks after surgical suturing of the Achilles tendon using a Kessler's suture (ATSSKS). We hypothesized a higher number, frequency, and intensity of supervised physiotherapy visits (HNFISVPhVs) would correlate with and significantly improve RIT and RPT for FPFM. MATERIAL AND METHODS Group A included 20 patients (x=47 visits) after ATSSKS with one SVPh protocol who were divided into subgroups: with HNFISVPhVs (x=72) and with a lower number, frequency, and intensity of SVPh visits (LNFISVPhVs, x=33). Twenty participants without Achilles tendon rupture were included in group B (control). Both groups (≥7 Tegner activity scale) underwent RIT, RPT, and Limb Symmetry Index (LSI) measurements using Biodex Medical System 3. RESULTS FPFM RIT were significantly lower in operated limbs in group A than for non-operated limbs in group B (P≤0.001). HNFISVPhVs correlated with higher FPFM RIT and LSI in operated limbs (from r=0.444, P=0.05 to r=0.585, P=0.007). HNFISVPhVs obtained higher LSI of FPFM RPT of 180°/s (P=0.022) and 30°/s (P=0.049) than LNFISVPhVs. CONCLUSIONS SVPh with 47 visits after ATSSKS for 28 weeks was insufficient to obtain equal values of RIT for FPFM and FDFM, but HNFISVPhVs correlated with higher RIT values and considerably improved RIT and RPT for FPFM compared with LNFISVPhVs.

Supervised Physiotherapy Improves Three-Dimensional (3D) Gait Parameters in Patients after Surgical Suturing of the Achilles Tendon Using an Open Method (SSATOM).

BACKGROUND: The aim of this study was to assess the effectiveness of 38 supervised postoperative physiotherapy (SVPh) visits conducted between 1 and 20 weeks after SSATOM on the values of 3D gait parameters measured at 10 and 20 weeks after surgery. MATERIAL: Group I comprised male patients (n = 22) after SSATOM (SVPh x = 38 visits) and Group II comprised male patients (n = 22) from the control group. METHODS: A non-randomized, open-label, controlled clinical trial was performed in the two groups to obtain the following values: Step length (cm), stride length (cm), step width (cm), next stance phase (%), swing phase (%), double support (%), gait velocity (m/s), and walking frequency (step/min). The measurements were carried out using the BTS SMART system (Italy). RESULTS: Orthopedic examination showed no pain, a negative result of Thompson and Matles tests, and proper healing of Achilles tendon (ultrasound image). In Group I, between 10 and 20 weeks after SSATOM, there was a statistically significant improvement in all tested gait parameter values (p ≤ 0.001 to 0.009). CONCLUSIONS: Conducting 38 SVPh visits significantly improved the values of the analyzed kinematic and spatiotemporal gait parameters in patients in the twentieth week after SSATOM, which were mostly close to the non-operated side and the results of the control group. However, the gait speed and stride length were not close to the results of the control group.

Ground Reaction Forces during Vertical Hops Are Correlated with the Number of Supervised Physiotherapy Visits after Achilles Tendon Surgery.

The objective of this study was to assess the effectiveness of, and the correlation between, an average of 42 supervised physiotherapy (SVPh) visits for the vertical ground reaction forces component (vGRF) using ankle hops during two- and one-legged vertical hops (TLH and OLH, respectively), six months after the surgical suturing of the Achilles tendon using the open method (SSATOM) via Keesler's technique. Hypothesis: Six months of supervised physiotherapy with a higher number of visits (SPHNVs) was positively correlated with higher vGRF values during TLH and OLH. Group I comprised male patients (n = 23) after SSATOM (SVPh x = 42 visits), and Group II comprised males (n = 23) without Achilles tendon injuries. In the study groups, vGRF was measured during TLH and OLH in the landing phase using two force plates. The vGRF was normalized to the body mass. The limb symmetry index (LSI) of vGRF values was calculated. The ranges of motion of the foot and circumferences of the ankle joint and shin were measured. Then, 10 m unassisted walking, the Thompson test, and pain were assessed. A parametric test for dependent and independent samples, ANOVA and Tukey's test for between-group comparisons, and linear Pearson's correlation coefficient calculations were performed. Group I revealed significantly lower vGRF values during TLH and OLH for the operated limb and LSI values compared with the right and left legs in Group II (p ≤ 0.001). A larger number of visits correlates with higher vGRF values for the operated limb during TLH (r = 0.503; p = 0.014) and OLH (r = 0.505; p = 0.014). An average of 42 SVPh visits in 6 months was insufficient to obtain similar values of relative vGRF and their LSI during TLH and OLH, but the hypothesis was confirmed that SPHNVs correlate with higher relative vGRF values during TLH and OLH in the landing phase.

The Muscle Strength of the Knee Joint after ACL Reconstruction Depends on the Number and Frequency of Supervised Physiotherapy Visits.

The aim of this study in anterior cruciate ligament reconstruction (ACLR) patients was to assess the effect of six months of supervised physiotherapy with a higher number of visits (SPHNV) compared to supervised physiotherapy with a lower number of visits (SPLNV) on the maximal peak torque (PT) and isometric torque (IT) of values obtained for hamstring (H) and quadriceps (Q) muscles of the knee joints under isokinetic and isometric conditions. Hypothesis: SPHNV improves IT and PT more than SPLNV. Group I had ACLR with a higher number of visits (n = 20), Group II had ACLR with a lower number of visits (n = 20), and Group III served as the control (n = 20). In Groups I and II, IT values were measured for quadriceps and hamstring muscles of the knee joints in the 13th and 24th weeks and for PT in the 18th and 24th weeks after ACLR (60 and 180 °/s). In group III, the measurements were taken once. The isometric torque and isokinetic peak torque values were measured in N*m and they were normalized to body mass as relative IT (RIT) and relative PT (RPT) were expressed in N*m/kg. Results: In both ACLR groups, the RIT and RPT values obtained from the operated knee joints significantly increased in the 24 weeks following ACLR compared to the uninvolved side. Group II had significantly lower RIT and RPT values for quadriceps and hamstring muscles of the operated limbs compared with the uninvolved limbs (p = 0.008, p = 0.001). In group I, the larger number of visits positively correlated with the higher PT for quadriceps and hamstring muscles of the operated and uninvolved knees (from r = 0.506; p = 0.023 too r = 0.566; p = 0.009), respectively. Six months of SPHNV positively correlated with and improved the IT and PT values in patients after ACLR much more significantly than six months of SPLNV.

Assessment of Effectiveness of 15 Weeks of Physical Therapy on Biplanar Ankle Mobility, Gait and Pain Level in Patients Following Operative Repair of the Achilles Tendon.

BACKGROUND: The aim of the study was to assess the effectiveness of 15 weeks of physical therapy on biplanar ankle mobility, gait and pain level in patients following operative repair of the Achilles tendon. MATERIAL AND METHODS: The study enrolled two groups of patients; a group of men (n=40) after operative repair of the Achilles tendon, who underwent 15 weeks of postoperative physiotherapy (Group I) and a group of men (n=40) without Achilles tendon injury (Group II). The ranges of motion for supination, pronation, plantar and dorsiflexion of the foot were measured in both groups. The ankle and shin circumferences were also measured. 10-meter unassisted walking, the Thom-son test results and pain according to a VAS scale were assessed. In Group I the tests were carried out after 5 and 20 weeks following open Achilles tendon repair. A test for dependent samples was used to compare within-group statistics and the ANOVA and Tukey's tests were used for between-group comparison. RESULTS: After 15 weeks of postoperative physical therapy, the patients in Group I had regained the ability to walk unassisted, all measured ranges of motion had improved significantly (from p=0.0001 to p=0.001), the ankle circumference on the operated side had decreased (p=0.002) and no pain was reported. However, the between-group comparison showed persistent, significantly decreased values of supination and plantar flexion on the operated side (p=0.001). CONCLUSIONS: 1. 15 weeks of postoperative physical therapy after open Achilles tendon repair restored painless function of the ankle joint and unassisted walking. 2. Despite a significant improvement in the range of motion, supination and plantar flexion of the foot on the operated side were not fully restored.

Diagnostic value of the hamstring to quadriceps ratio in monitoring of the effectiveness of supervised 6-month physiotherapy in males after Anterior Cruciate Ligament Reconstruction (ACLR).

PURPOSE: The aim of the study was to assess the usefulness of isometric torque (IT) and peak torque (PT) of the hamstring to quadriceps muscles ratio (H/Q ratio) in monitoring the effectiveness of physiotherapy (PH) in males after ACLR. HYPOTHESIS: The H/Q ratio is a diagnostic tool for monitoring of the effectiveness of the 6- month PH after ACLR. METHODS: Twenty males 6 months after ACLR (ACLR group) and 20 male controls underwent IT and PT (60°/s and 180°/s) bilateral measurements of H and Q muscles. The IT and PT were normalized to body mass, and expressed as relative IT (RIT) and relative PT (RPT). The RIT and RPT H/Q ratios, and Limb Symmetry Index (LSI) were calculated. RESULTS: In the ACLR group, the RIT for the H and Q, the RIT for the H/Q ratio and most of the RPT, as well as the H/Q ratio, ROM and LSI values of the operated knee, were not significantly different (NSD) than those of the non-operated side (NOS) or the control group. The between-group comparison of the H/Q ratio for RIT and RPT weren't NSD. The isokinetic test at 180 °/s showed lower RPT, H/Q ratio and LSI values for the Q muscle than those of the NOS (p = 0.042, p = 0.001). CONCLUSIONS: The H/Q ratio, in combination with the RIT, RPT and LSI, is a useful diagnostic tool for monitoring the effectiveness of 6-month PH after ACLR. Restoring the correct H/Q ratio can reduce the risk factor for ACL graft rupture.

Arthrofibrosis of the Knee Joint - the Current State of Knowledge. Literature Review.

The objective of the paper is to highlight the interdisciplinary problem of arthrofibrosis (AF) and to present this problem from the physiotherapy angle based on a literature review and the authors' experience. Arthrofi-brosis is a pain-ful condition limiting joint mobility due to pathological fibrosis involving scarring. The limited mobility is often ac-companied by pain. Arthrofibrosis may result in limited locomotion in everyday life or at work and withdrawal from physical activity. In severe cases, Severe AF can lead to patients' unemployability due to their inability to perform certain work-related activities. The problem is important from the clinical point of view, and therefore treatment of AF involves specialists, physiotherapists and psychologists. Our paper presents the definitions of AF, the most fre-quent causes and epidemiology of the dysfunction. This is followed by a classification of arthrofibrosis. Special attention is paid to problems connected with AF-related terminology. The consequences of the disease, such as pain, inflammation and impairment of joint function, especially joint range of motion limitation, are also presented. The relationship between AF and decreased muscle strength is discussed as well as the ways of muscle strength genera-tion and the issue of limited locomotion in patients with this condition. Some emphasis is given to the role of con-servative and surgical treatment as well as physiotherapy for the prevention or reduction of AF consequences. The next section presents the main guidelines for early physiotherapy. The goal of early physiotherapeutic intervention is to prevent excessive fibrosis within the knee joint and enable safe recovery of joint mobility. The conclusions high-light the need to conduct further research and develop a standard for physiotherapeutic intervention within a com-prehensive evidence-based treatment approach to arthrofibrosis.

Peak torque angle of anterior cruciate ligament-reconstructed knee flexor muscles in patients with semitendinosus and gracilis autograft is shifted towards extension regardless of the postoperative duration of supervised physiotherapy.

BACKGROUND: The observational cohort study investigated whether the flexor muscles peak torque (PT) angle shifting towards extension observed in the involved knee in patients after anterior cruciate ligament reconstruction (ACLR) using semitendinosus and gracilis tendon (STGR) autograft is associated with the postoperative physiotherapy supervision duration. METHODS: From 230 ACL-reconstructed males, we identified patients after ACLR utilizing STGR autograft and divided them into those who completed supervised physiotherapy <6 months (Group I; n = 77) and those who completed supervised physiotherapy ≥6 months (Group II; n = 66). The mean follow-up time was 6.84 ± 1.47 months. The ACL-reconstructed patients were compared to 98 controls (Group III). Bilateral knee flexor muscle PT measurements were performed. The relative PT at 180°/s (RPT), PT angle at 180°/s, and range of motion at 180°/s were analysed. The RPT limb symmetry index (LSI) was calculated. Tests for dependent samples, one-way analysis of variance, post hoc test, and linear Pearson's correlation coefficient (r) calculations were performed. RESULTS: The shift towards extension was noted when comparing the ACL-reconstructed limb to the uninvolved limb (Group I, p ≤ 0.001; Group II, p ≤ 0.001) and to Group III (p ≤ 0.001), but it was not correlated with physiotherapy supervision duration (r = -0.037, p = 0.662). In ACL-reconstructed patients, there was a moderate association of supervision duration and knee flexor LSI (r = 0.587, p < 0.001). CONCLUSIONS: The ACL-reconstructed knee flexors PT angle shift towards extension was observed regardless of the duration of postoperative physiotherapy supervision. However, the analysis revealed that the duration of supervised physiotherapy positively influenced the RPT and LSI in patients after the ACLR.

A comparative clinical and functional assessment of cortical button versus suture anchor in distal biceps brachii tendon repair.

PURPOSE: The studies comparing the fixation methods being used for the ruptured distal biceps brachii tendon reinsertion show similar outcomes of cortical button and suture anchors usage, however, longer follow-up studies remain necessary. The goal of this study was to compare the clinical and functional three-year outcomes of the cortical button in contrast to the suture anchor fixation. METHODS: A retrospective cohort study comprised of 28 males on average 3 years after surgical reinsertion of the distal biceps brachii tendon with the use of a cortical button (Group I, n = 11) or a suture anchor (Group II, n = 17). The outcomes assessed were range of elbow joint and forearm motion (ROM), arm circumferences, visual analogue scale (VAS), Mayo Elbow Performance Index (MEPI), Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) and forearm flexor and supinator muscle torques measured under isometric and isokinetic conditions. RESULTS: The comparison between the two studied groups revealed no statistically significant differences in ROM (p = 0.24-1.00), circumferences (p = 0.15-0.50), VAS (p = 0.71), MEPI (p = 0.23), Quick DASH (p = 0.61) or in the obtained muscle torque values (p = 0.07-1.00). However, differences in supination ROM between the surgical and non-surgical side were found in both groups (p = 0.01-0.02), and differences in pronation (p = 0.02) were found in Group II. The muscle torque values obtained in the surgical, dominant limb were lower than those in the nonsurgical, nondominant limb. CONCLUSION: The comprehensive comparison of three-year outcomes of cortical button versus suture anchor fixations did not favour one fixation method over the other, and the results justify the clinical usage of both methods.

Are the knee extensor and flexor muscles isokinetic parameters affected by the duration of postoperative physiotherapy supervision in patients eight months after ACL reconstruction with the use of semitendinosus and gracilis tendons autograft?

PURPOSE: The observational study evaluated isokinetic parameters in patients at eight months after anterior cruciate ligament reconstruction (ACLR) utilizing semitendinosus and gracilis tendons autograft, with two different modes of physiotherapy, and investigated whether analysed parameters were affected by the postoperative physiotherapy supervision duration. METHODS: Strict exclusion criteria were employed on a group of 259 ACL-reconstructed patients to identify two groups of males preoperatively well trained and frequently participating in sports, with different durations of postoperative physiotherapy supervision: Group I (n = 18; x = 27.67 weeks) and Group II (n = 20; x = 10.75 weeks). The patients underwent knee extensor and flexor muscles torques measurements with the 180°/s and 60°/s. The torque, position and time parameters were analysed. Limb Symmetry Index (LSI) was calculated. The parametric tests for dependent samples, parametric tests for independent samples, and linear Pearson's correlation coefficient calculations were performed. RESULTS: There were significant between-limb differences in the Group II in the knee extensor and flexor muscles torque parameters, with LSI ranging from x = 75.72 to x = 78.75 and from x = 78.69 to x = 87.82, respectively. The knee extensor muscles torque parameters and LSI values were positively correlated with the physiotherapy supervision duration. The inter-limb differences in the Group I and II in knee flexor muscles PT angle amounted to x = 10.94° (180°/s), x = 9.39 ° (60°/s), and x = 12.00°(180°/s), x = 9.75° (60°/s), respectively. CONCLUSIONS: The longer postoperative physiotherapy supervision was more effective for improving knee muscles torque parameters. The knee flexor muscles PT angle was shifted towards extension in the ACL-reconstructed limb, regardless of the time of postoperative physiotherapy supervision duration.

Effects of Postoperative Physiotherapy Supervision Duration on Clinical Outcome, Speed, and Agility in Males 8 Months After Anterior Cruciate Ligament Reconstruction.

BACKGROUND We investigated whether the duration of postoperative physiotherapy supervision by a physiotherapist affects clinical outcome, speed, and agility in males 8 months after anterior cruciate ligament reconstruction (ACLR). MATERIAL AND METHODS From a group of 248 patients 8 months after ACLR, we used strict exclusion criteria to identify 2 groups of men who were well trained and frequently participated in sports pre-injury, with different durations of postoperative physiotherapy supervision: Group I (n=15; x=27.40 weeks) and Group II (n=15; x=8.07 weeks). Group III (n=30) were controls. Clinical evaluation (manual ligament assessment, knee joint and thigh circumferences, range of motion), pain assessment, and run test with maximal speed and change-of-direction manoeuvres, was performed. RESULTS No clinically significant abnormalities were noted in any studied groups in terms of clinical and pain assessments. The time of the run test was significantly increased in Group II (x=23.77 s) compared with Group I (x=21.76 s) and Group III (x=21.15 s). The average speed was significantly reduced in Group II (x=2.05 m*s-1) compared with Group I (x=2.22 m*s-1) and Group III (x=2.27 m*s-1). The duration of physiotherapy supervision was significantly negatively correlated with the time results of the run test (r=-0.353; p=0.046) and positively correlated with the average speed (r=0.360; p=0.049). CONCLUSIONS Both shorter and longer duration of postoperative physiotherapy supervision resulted in successful clinical outcomes in terms of studied features in males 8 months after ACLR. Nevertheless, longer physiotherapy supervision was more effective for improving speed and agility to the level of healthy individuals.

Two-Plane Assessment of Knee Muscles Isometric and Isokinetic Torques After Anterior Cruciate Ligament Reconstruction.

BACKGROUND We tested the hypothesis that, in patients participating in 17 weeks of postoperative physiotherapy after anterior cruciate ligament reconstruction (ACLR), maximal isometric torque (IT) and peak torque (PT) generated by the muscles affecting the operated knee joint in the sagittal and transverse planes are not restored. We also present the application of IT and PT measurements of the muscles affecting the knee joint in 2 planes of motion. MATERIAL AND METHODS IT and PT of the knee extensor and flexor muscles and the muscles internally rotating the shin were measured in 30 males who participated in postoperative physiotherapy for 17 weeks after ACLR (ACLR group) and 30 males with no injuries (control group). RESULTS Significantly lower IT and PT values were noted in the operated knee extensors and flexors. The differences were also noted in the PT for the muscles internally rotating the shin and in the IT of those muscles in the position of 25° of internal rotation. Significantly lower relative IT and PT values were noted for studied muscle groups in comparison to the control group. CONCLUSIONS Seventeen weeks of postoperative physiotherapy after ACLR did not result in complete restoration of IT and PT of the muscles affecting the operated knee joint, suggesting that even after 17 weeks of physiotherapy following ACLR, athletes may not be ready to return to sports. The results demonstrate the usefulness of biplanar analysis of muscle strength under isometric and isokinetic conditions in the monitoring and assessment of physiotherapeutic procedures.

The Effect of Longer versus Shorter Duration of Supervised Physiotherapy after ACL Reconstruction on the Vertical Jump Landing Limb Symmetry.

The study investigated the vertical jump landing limb symmetry after ACLR between a group of patients receiving a longer supervised physiotherapeutic procedure and following a shorter supervised physiotherapy. Group I (n = 20) and Group II (n = 15) were males averagely 30 weeks after ACLR. The time since ACLR in both groups (Group I, 27.95 ± 8.26 weeks; Group II, 32.47 ± 7.74 weeks) was insignificant, although the duration of supervised physiotherapy between the two groups (Group I, 27.9 ± 8.26 weeks; Group II, 11.28 ± 8.20 weeks) significantly differenced. Group III (n = 20) were controls. Two-legged and one-legged vertical jumps landing vertical ground reaction force (VGRF) were bilaterally measured in all groups using force plates. The intragroup comparison of two-legged jump landing VGRF revealed p = 0.01 between the involved and uninvolved limbs in Group II. The intergroup comparison revealed p ≤ 0.001 in the two-legged vertical jump between Groups II and III, and I and II. The one-legged limb symmetry was comparable in studied groups. In the group following shorter supervised physiotherapy, the two-legged landing limb symmetry was on a worse level than in the group of patients receiving fully supervised procedure and healthy individuals. A fully supervised postoperative physiotherapy is more effective for improving two-legged vertical jump landing limb symmetry.

Surgical Management of Distal Biceps Tendon Anatomical Reinsertion Complications: Iatrogenic Posterior Interosseous Nerve Palsy.

BACKGROUND Although iatrogenic posterior interosseous nerve (PIN) palsy is an uncommon complication of ruptured distal biceps brachii tendon surgical anatomical reinsertion, it is the most severe complication leading to functional limitation. The present study investigated possible types of PIN palsy as a postoperative complication of anatomical distal biceps tendon reinsertion, and aimed to clinically assess patients at 2 years after its surgical treatment. MATERIAL AND METHODS The studied sample comprised 7 male patients diagnosed with an iatrogenic PIN palsies after anatomical reinsertion of the distal biceps tendon, who were referred to the reference center for management of a peripheral nervous system injury. The nerve injury was intraoperatively evaluated. The clinical assessment used the Medical Research Council (MRC) System for motor recovery, and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) was performed before the surgical treatment of the PIN injuries and at 2 years postoperatively. In all studied cases, electromyography was performed preoperatively and postoperatively. RESULTS The comparison of the preoperative (x=1.43±0.53) and postoperative (x=4.71±0.49) results of the motor recovery of the PIN demonstrated a statistically significant improvement (p<0.001). Moreover, the results of functional assessments with the use of the Quick DASH questionnaire significantly improved (p<0.001) postoperatively (x=6.14±6.86) compared to the preoperative evaluations (x=54.29±12.05). CONCLUSIONS The PIN palsies as complications of the surgical anatomical reinsertion of ruptured distal biceps brachii resulted from mechanical nerve compression or direct intraoperative damage. The 2-year outcomes justified the clinical use of surgical management for iatrogenic PIN palsy.

Treatment of Distal Biceps Tendon Injuries with Particular Emphasis on Postoperative Physiotherapy.

Distal biceps tendon injuries are relatively rare. Standard treatment of complete tears and significant partial tears involves surgical anatomical reinsertion of the tendon at the radial tuberosity. Chronic injuries are usually managed with surgical tendon reconstruction using autografts or allografts. Conservative treatment is mostly limited to the elderly, individuals with a very low level of physical activity, patients with evident contraindications to surgical treat-ment, and cases of mild partial tendon tears. The selection of an optimum surgical technique and method of fixation remains controversial. The aim of this paper is to characterize distal biceps tendon injuries, discuss methods of their surgical treatment, and analyze postoperative physiotherapy regimens described in the literature. A literature review did not reveal any relationship between the surgical method and type of fixation used on the one hand and the period of immobilization, type of immobilization, or the postoperative physiotherapy regimen on the other.

Synthetic grafts in the treatment of ruptured anterior cruciate ligament of the knee joint.

The anterior cruciate ligament (ACL) is cited as the most frequently injured ligament in the knee. The standard treatment of ACL injury remains ligament reconstruction followed by a postoperative physiotherapeutic procedure. During the reconstruction, the torn ligament can be replaced with an autograft or an allograft. A synthetic ligament is also one of the available graft options. Synthetic grafts in ruptured ACL treatment have been used as scaffolds, stents, or prostheses. The story of using synthetic materials in ACL deficient knee treatment started in the beginning of the 20th century with the usage of silk and silver fibers. The second half of the 20th century abounded in new synthetic materials being proposed as torn ACL replacements, such as Supramid®, Teflon® or Dacron®, Proplast®, carbon fiber graft, ABC graft, Kennedy-LAD®, Trevia, Leeds-Keio, Gore-Tex®, PDS®, EULIT®, and Polyflex® or LARS®. Artificial ligaments have intrigued surgeons for all these years as they represent the hope for grafts that are easily available and stronger than soft tissue "off-the-shelf" grafts, simplifying the surgery, and avoiding graft harvesting and donor site morbidity. However, most of the artificial grafts have been characterized by high rates of failure. One of the very few synthetic grafts gaining more widespread popularity has been LARS®. However, it is suggested that the ligament not be considered as a potential graft for primary reconstruction of the ACL, and it should be rather treated as an alternative graft in special cases, so the optimal synthetic graft material remains controversial.

Retrospective Evaluation of Surgical Anatomical Repair of Distal Biceps Brachii Tendon Rupture Using Suture Anchor Fixation.

BACKGROUND To date, no consensus has been reached regarding the preferred fixation method to use in the repair of distal biceps brachii tendon rupture. The aim of this study was to clinically and functionally (Mayo Elbow Performance Index, MEPI) assess the upper limb after surgical anatomic reinsertion of the distal biceps brachii tendon with the use of suture anchor fixation method with regard to postoperative time and limb dominance, and to assess postoperative complications. MATERIAL AND METHODS The sample comprised 18 males (age 52.09±8.89 years) after surgical anatomical distal biceps brachii reinsertion using suture anchor fixation. A comprehensive clinical and functional evaluation and pain assessment were performed. RESULTS In terms of postoperative complications, an isolated case of surgical site sensory disturbances was noted. Circumferences (p-value 0.21-1.00) and ROM (p-value 0.07-1.00) were similar in the operated and nonoperated limbs. The isometric torque (IT) values of muscles flexing and supinating the forearm were comparable in both limbs (p-value 0.14-0.95), but in patients with the operated dominant limb, the mean IT value was not higher than the value obtained in the nonoperated nondominant one. The MEPI indicated good and excellent results (80.00±15.00-90.00±8.66 points), but a detailed individual analysis showed that reported scores were not in line with objectively measured features. CONCLUSIONS The results of the comprehensive retrospective evaluation justify the clinical use of suture anchors fixation method in the surgical anatomical reinsertion of a ruptured distal biceps brachii tendon. The assessment of a patient should always report both subjective and objective measures.

Dependence of Gait Deviation on Weight-Bearing Asymmetry and Postural Instability in Children with Unilateral Cerebral Palsy.

Postural control deficits have been suggested to be a major component of gait disorders in children with cerebral palsy. The purpose of this study was to investigate the relationship between postural stability and treadmill walking, in children with unilateral cerebral palsy, by defining dependence between the posturographic weight-bearing distribution and center of pressure (CoP) sway during quiet standing with Gillette Gait Index and the 16 distinct gait parameters that composed the Gillette Gait Index. Forty-five children with unilateral cerebral palsy from 7-12 years of age were included in this study. A posturographic procedure and 3-dimensional instrumented gait analysis was developed. In general, across the entire tested group, the significant correlations concerned only the asymmetry of the weight bearing and a few of the distinct gait parameters that compose the Gillette Gait Index; moreover, correlation coefficients were low. The division of subjects into two clinical subgroups: children that exhibited a tendency to overload (1) and to underload (2) the affected body side, modified the results of the explored relationships. Our findings revealed that the difficulties experienced by children with hemiplegia while controlled in a standing position result from tendency to excessively or insufficiently load the affected lower limbs, and thus establishes a direct relationship with inadequate affected peak ankle DF in both stance and swing gait phases. Given the presented relationship between postural instability and deviation of the particular gait parameters in children with unilateral cerebral palsy, a follow-up study will be needed to determine the therapeutic approaches that will be most effective in promoting increased improvement in gait pattern, as well as the static and dynamic balance in standing.

Quantitative analysis of peak torque and power-velocity characteristics of shoulder rotator muscles after arthroscopic labral repair.

OBJECTIVES: We aimed to use biomechanical testing to assess differences in the power and strength of patients who participated in a short-term, home-based rehabilitation program following arthroscopic labral repair compared with a healthy control group. DESIGN: The functional outcomes of patients who underwent arthroscopic labral repair followed by self-directed short-term rehabilitation at home were compared with age- and body mass index (BMI)-matched healthy controls. METHODS: Group I included 20 male patients who had undergone arthroscopic labral repair after being diagnosed with recurrent anterior glenohumeral joint instability without bony lesions of the humeral head or glenoid. Postoperatively, they participated in physical therapy for 17±4 appointments, followed by self-guided home-based exercises. Group II included 25 males without injuries. The two groups were matched for age and BMI. The orthopaedic examination, functional tests, and biomechanical measurements were performed under isokinetic conditions at an average of 16±3 months postoperatively. RESULTS: Significant differences were observed in range of shoulder rotation on the operative shoulder compared with the unaffected side and in the dominant arms of the control group. The patients were also found to have significant deficits in biomechanical parameters such as power and peak torque angle. CONCLUSIONS: Significant deficits in peak torque, power, and peak torque angle during external and internal shoulder rotation remained up to 16 months after arthroscopic labral repair. Further research is needed to understand the changes in shoulder power assessment after labral repair.

Three-dimensional kinematic analysis of ankle, knee, hip, and pelvic rotation during gait in patients after anterior cruciate ligament reconstruction - early results.

BACKGROUND: The goal of this study was to biomechanically assess tibial rotation in the knee joint simultaneous changes in rotation of large joints of the lower limbs and pelvis during gait in patients during early postoperative stages following anterior cruciate ligament (ACLR) reconstruction. We hypothesized that tibial rotation is associated with changes in rotation of the large joints of the lower limbs and the pelvis during gait in patients after ACLR reconstruction. METHODS: The patients were divided into two groups. The ACLR group (n = 32 males) underwent primary ACLR in one leg and postoperative physiotherapy. The control group (n = 30 males) had no knee injuries. After clinical assessment in both groups, the values of kinematic parameters of foot, tibial, femoral, and pelvic rotation were measured during gait on a flat surface using the three-dimensional BTS Smart System. In the ACLR group, measurements were taken during the 4th, 9th, and 14th weeks of postoperative physiotherapy. The results of the ACLR group were compared with those of the control group. RESULTS: During gait, between the 9th and 14th weeks following ACLR, there are normal values of foot, tibia, and pelvic rotation in the operated legs compared with results obtained from un-operated legs and the control group. DISCUSSION: Analysis of rotations occurring only in knee joints does not reflect all of the multiarticular disorders of gait kinematics. The study also suggests that analyzing tibial rotation in the knee joint with simultaneous changes in rotation in large joints of the lower limbs provides better opportunities than singular analysis of rotation in the knee joint for the assessment of disorders in gait kinematics. CONCLUSIONS: In gait, at the maximal extension of the knee during preparation for the stance phase, external hip rotation patterns have not been fully restored 14 weeks after ACLR.